Venous Thromboembolism: Are NOACs the Right Initial Drug of Choice for Unprovoked Venous Thromboembolism?

To the Editor: Venous thromboembolism (VTE) is a common vascular disorder affecting approximately 500,000 people each year in the United States.1 With the advent of novel oral anticoagulants (NOACs), the treatment of VTE has been revolutionized, especially of provoked deep vein thrombosis.2 There remains a concern when VTE is...

Sports-Injury Encephalopathy

Sports-related encephalopathies are a growing concern among athletes who have experienced head trauma. Anxiety is heightened for the public and especially among parents of children playing contact sports. The most common neuropsychological conditions are concussions and traumatic encephalopathies. Concussions result from brain traumas that can be asymptomatic, but more...

Intravascular Iodinated Contrast Is an Independent Cause of Acute Kidney Injury Following Coronary Angiography

Objectives: Recent studies have questioned whether intravascular iodinated contrast remains an independent cause of acute kidney injury (AKI). We sought to assess whether iodinated contrast administered during coronary angiography is an independent cause of AKI.Methods: We identified all of the patients who underwent coronary angiography between July 1, 2015...

Commentary on “Use of Rheumatologic Testing in Patients Who Eventually Receive a Diagnosis of Rheumatoid Arthritis”

Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disorder of unknown etiology, for which delay in diagnosis and treatment may cause irreversible structural joint damage in affected individuals. A large body of evidence supports that early diagnosis and aggressive treatment of RA have a fundamental role in the...

Use of Rheumatologic Testing in Patients Who Eventually Receive a Diagnosis of Rheumatoid Arthritis

Objectives: Anti-cyclic citrullinated peptide antibody (ACPA) has excellent specificity and prognostic value in patients with early rheumatoid arthritis (RA). The American College of Rheumatology included ACPA in their 2010 classification criteria for RA, but we hypothesize that primary care physicians (PCPs) underuse ACPA, even when clinical suspicion for RA...

Transitions of Care for Healthy Young Adults: Promoting Primary Care and Preventive Health

The transition of care between pediatric and adult medicine is a challenging time for patients and physicians. This longitudinal process encompasses much more than the physical transfer of a patient between providers. Established transition of care processes and literature exist for many chronic disease populations, but little focus has...

Moral Controversy and Working with Colleagues with a Shared Ethical/Moral Outlook: A National Survey of US Primary Care Physicians

Noncarbapenems for the Treatment of Urinary Tract Infections Caused by Extended-Spectrum β-Lactamase-Producing Bacteria

 Objectives: Urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae are resistant to many conventional therapies, including third-generation cephalosporins. Carbapenems are considered first-line agents for ESBL infections, but their use is associated with increased multidrug resistance and should be reserved when absolutely necessary. Because of the increased rates...

OPEN: Developing and Piloting a Tool to Identify Food Insecurity in Older Adults

Objective: The literature shows that food insecurity (FI) can negatively affect the trajectory of many chronic illnesses. FI can be acutely severe for older adults, but screening for FI is not regularly performed in the hospital setting. Our goal was to develop a tool to screen for FI upon...

Weight-Bearing Physical Activity Influences the Effect of Vitamin D on Bone Turnover Markers in Patients with Intellectual Disability

Objectives: Individuals with intellectual disabilities (IDs) are at increased risk for low bone mass and fragility fractures, and those who are nonambulatory may be at even higher risk. Patients with IDs often are vitamin D deficient, but there is little information concerning how vitamin D treatment of patients with...

Prevalence and Predictors of Pulmonary Embolism in Hospitalized Patients with Syncope

Objectives: Approximately one in six patients hospitalized with syncope have pulmonary embolism (PE), according to the PE in Syncope Italian Trial study. Subsequent studies using administrative data have reported a PE prevalence of <3%. The aim of the study was to determine the prevalence and predictors of PE in...

Assessing the Availability of Pharmacotherapy Options for Tobacco Cessation in Tennessee’s Substance Use Facilities

Objectives: Smoking is deadly and exacerbates comorbid health conditions, especially among those with co-occurring substance use disorders. Tennessee does not require substance abuse treatment facilities to concurrently provide tobacco-cessation treatment options or limit smoking on facility property as a standard for licensure. This study examines the relation between Tennessee...

Choice of Intravenous Crystalloid Fluid and Mortality in Critically Ill Adult Patients

Objectives: Intravenous balanced crystalloid fluid therapy may improve mortality and other outcomes in critically ill adult patients, but data are conflicting. We conducted a meta-analysis and literature review to evaluate the impact of intravenous balanced crystalloid, as compared with normal saline, fluid therapy on outcomes in critically ill adult...

Commentary on “An Updated Approach to Evaluation and Treatment of Helicobacter pylori Infection”

This issue of the Southern Medical Journal contains an important and timely review of Helicobacter pylori diagnosis and treatment.1 Since its discovery in 1983, H. pylori infection has been found to be the main cause of peptic ulcer disease, chronic gastritis, gastric cancer, and mucosa-associated lymphoid tissue...

An Updated Approach to Evaluation and Treatment of Helicobacter pylori Infection

Helicobacter pylori is a chronic bacterial infection that can lead to peptic ulcer disease, chronic gastritis, and gastric cancer. Its prevalence in the United States is lower than in most of the world, although specific populations are at particular risk for disease-related complications, including those with lower socioeconomic status...

Prevalence of Systemic Hypertension Among HIV-Infected and HIV-Uninfected Young Adults in Baltimore, Maryland

Objectives: Adults with perinatally acquired human immunodeficiency virus (PHIV) infection may be at increased risk for nonacquired immunodeficiency syndrome (AIDS) diseases, including systemic hypertension (HTN). The purpose of this study was to examine the prevalence of HTN among young adults with PHIV compared with recently infected and uninfected young...

Patients on Involuntary Hold Status in the Emergency Department

Summary of Selected Healthcare Encounters among a Selection of Patients with Myotonic Muscular Dystrophy

Objective: Research has not examined the use of health care by patients with myotonic muscular dystrophy (MMD), but it would provide insights into this population, which is prone to comorbidities and high service needs. This study is an analysis of this understudied subgroup, using a unique linked dataset to...

Fetal Hemoglobin Modulators May Be Associated With Symptomology of Football Players with Sickle Cell Trait

Objectives: This study investigates whether genetic modifiers previously shown to influence adult fetal hemoglobin (HbF) levels and glucose-6-phosphate dehydrogenase deficiency were associated with variable symptomology in a small sample of collegiate football players with sickle cell trait.Methods: Survey data on self-assessed symptoms and genotype data from five single nucleotide...

Otolaryngology: Breadth, Depth, Challenge, and Choice

Otolaryngology – head and neck surgery (ORL-HNS) is not only one of the most competitive disciplines for students seeking residency, but it also is one of the most complex, challenging, and flexible fields in medicine, especially in surgery. Unfortunately, with only 106 accredited allopathic otolaryngology residency programs and 179...